Robert Holloway's List: ADHD Info

Inattention

Children who are inattentive have a hard time keeping their minds on any one  thing and may get bored with a task after only a few minutes. If they are doing  something they really enjoy, they have no trouble paying attention. But focusing  deliberate, conscious attention to organizing and completing a task or learning  something new is difficult.

Homework is particularly hard for these children. They will forget to write  down an assignment, or leave it at school. They will forget to bring a book  home, or bring the wrong one. The homework, if finally finished, is full of  errors and erasures. Homework is often accompanied by frustration for both  parent and child.

The DSM-IV-TR gives these signs of inattention:

 
• Often becoming easily distracted by irrelevant sights and sounds  
• Often failing to pay attention to details and making careless mistakes  
• Rarely following instructions carefully and completely losing or forgetting  things like toys, or pencils, books, and tools needed for a task  
• Often skipping from one uncompleted activity to another.

Children diagnosed with the Predominantly Inattentive Type of ADHD are seldom  impulsive or hyperactive, yet they have significant problems paying attention.  They appear to be daydreaming, “spacey,” easily confused, slow moving, and  lethargic. They may have difficulty processing information as quickly and  accurately as other children. When the teacher gives oral or even written  instructions, this child has a hard time understanding what he or she is  supposed to do and makes frequent mistakes. Yet the child may sit quietly,  unobtrusively, and even appear to be working but not fully attending to or  understanding the task and the instructions.

These children don’t show significant problems with impulsivity and  overactivity in the classroom, on the school ground, or at home. They may get  along better with other children than the more impulsive and hyperactive types  of ADHD, and they may not have the same sorts of social problems so common with  the combined type of ADHD. So often their problems with inattention are  overlooked. But they need help just as much as children with other types of  ADHD, who cause more obvious problems in the classroom.

Whatever the specialist’s expertise, his or her first task is to gather  information that will rule out other possible reasons for the child’s behavior.  Among possible causes of ADHD-like behavior are the following:

 
• A sudden change in the child’s life—the death of a parent or grandparent;  parents’ divorce; a parent’s job loss  
• Undetected seizures, such as in petit mal or temporal lobe seizures  
• A middle ear infection that causes intermittent hearing problems  
• Medical disorders that may affect brain functioning  
• Underachievement caused by learning disability  
• Anxiety or depression.

Ideally, in ruling out other causes, the specialist checks the child’s school  and medical records. There may be a school record of hearing or vision problems,  since most schools automatically screen for these. The specialist tries to  determine whether the home and classroom environments are unusually stressful or  chaotic, and how the child’s parents and teachers deal with the child.

Next the specialist gathers information on the child’s ongoing behavior in  order to compare these behaviors to the symptoms and diagnostic criteria listed  in the DSM-IV-TR. This also involves talking with the child and, if possible,  observing the child in class and other settings.

The child’s teachers, past and present, are asked to rate their observations  of the child’s behavior on standardized evaluation forms, known as behavior  rating scales, to compare the child’s behavior to that of other children the  same age. While rating scales might seem overly subjective, teachers often get  to know so many children that their judgment of how a child compares to others  is usually a reliable and valid measure.

The specialist interviews the child’s teachers and parents, and may contact  other people who know the child well, such as coaches or baby-sitters. Parents  are asked to describe their child’s behavior in a variety of situations. They  may also fill out a rating scale to indicate how severe and frequent the  behaviors seem to be.

In most cases, the child will be evaluated for social adjustment and mental  health. Tests of intelligence and learning achievement may be given to see if  the child has a learning disability and whether the disability is in one or more  subjects.

In looking at the results of these various sources of information, the  specialist pays special attention to the child’s behavior during situations that  are the most demanding of self-control, as well as noisy or unstructured  situations such as parties, or during tasks that require sustained attention,  like reading, working math problems, or playing a board game. Behavior during  free play or while getting individual attention is given less importance in the  evaluation. In such situations, most children with ADHD are able to control  their behavior and perform better than in more restrictive situations.

The specialist then pieces together a profile of the child’s behavior. Which  ADHD-like behaviors listed in the most recent DSM does the child show? How  often? In what situations? How long has the child been doing them? How old was  the child when the problem started? Are the behavior problems relatively chronic  or enduring or are they periodic in nature? Are the behaviors seriously  interfering with the child’s friendships, school activities, home life, or  participation in community activities? Does the child have any other related  problems? The answers to these questions help identify whether the child’s  hyperactivity, impulsivity, and inattention are significant and long-standing.  If so, the child may be diagnosed with ADHD.

A correct diagnosis often resolves confusion about the reasons for the  child’s problems that lets parents and child move forward in their lives with  more accurate information on what is wrong and what can be done to help. Once  the disorder is diagnosed, the child and family can begin to receive whatever  combination of educational, medical, and emotional help they need. This may  include providing recommendations to school staff, seeking out a more  appropriate classroom setting, selecting the right medication, and helping  parents to manage their child’s behavior.